(12) Patent Application Publication (10) Pub. No.: US 2010/ A1

Transcription

1 (19) United States US A1 (12) Patent Application Publication (10) Pub. No.: US 2010/ A1 Johnson et al. (43) Pub. Date: May 20, 2010 (54) REVERSE SHOULDER PROSTHESIS (75) Inventors: Garth Johnson, Co Durham (GB); Andreas Kontaxis, Newcastle upon Tyne (GB); Angus Wallace, Nottingham (GB) Correspondence Address: TOWNSEND AND TOWNSEND AND CREW, LLP TWO EMBARCADERO CENTER, EIGHTH FLOOR SAN FRANCISCO, CA (US) (73) Assignee: The University of Newcastle Upon Tyne, Newcastle upon Tyne (GB) (21) Appl. No.: 12/522,681 (22) PCT Filed: Jan. 17, 2008 (86). PCT No.: PCT/GBO8/OO154 S371 (c)(1), (2), (4) Date: Dec. 28, 2009 (30) Foreign Application Priority Data Jan. 18, 2007 (GB)... O7OO940.O Publication Classification (51) Int. Cl. A6IF 2/40 ( ) (52) U.S. Cl /19.14; 623/19.11 (57) ABSTRACT A Scapula component (1) for a reverse shoulder prosthesis comprises a part spherical, convex, Surface (3) which is less than a hemisphere. The part spherical Surface does not have a rotational axis of symmetry, and may include a main circular Surface portion and one or more subsidiary Surface portions (5, 6, 7) depending from an edge of the main Surface portion. A humerus component (200) for a reverse shoulder prosthesis comprises a cup member (202) having a part spherical, con cave bearing surface (206) surrounded by an oval rim (208).

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12 Patent Application Publication May 20, 2010 Sheet 11 of 16 US 2010/O A ILow 001, O9 (81 H.0?,

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18 US 2010/O A1 May 20, 2010 REVERSE SHOULDER PROSTHESIS The present invention relates to a shoulder prosthe sis, and in particular to a Scapula component and a humerus component which together form a reverse shoulder prosthe sis Reverse (or inverse) shoulder prostheses are known. Such prostheses are termed reverse as they reproduce the Scapula-humerus interaction in reverse. In a normal shoulder, a spherical element located on the proximal end of the humerus interacts with the glenoid cavity on the Scapula. In a reverse shoulder prosthesis the spherical element is located on the Scapula and the cavity, which interacts with the spheri cal element, is located on the proximal end of the humerus. Reverse shoulder prostheses are typically used in the event of serious muscular degeneration of the shoulder, particularly of the rotator cuff muscles. The degeneration of Such muscles causes a prevalent action by the deltoid which tends to draw the humerus upwards and raises the risk of it contacting the acromion on the Scapula. To avoid this contact the shoulder joint is reversed. The reverse shoulder prosthesis provides stability to the joint and maximises mobility of the shoulder. Reverse shoulder prostheses are the most common form of prosthesis used to treat severe rotator cuff tears. 0003) A significant problem with existing reverse shoul der prostheses is impingement of the humerus component of the prosthesis on the inferior border of the scapula. Contact with the Scapula caused by the impingement may create notches in the bone. These notches may result in bone loss and loosening of the Scapula component of the prosthesis. Studies have shown that in 62% of patients with reverse shoulder prostheses, notching is observed within 2 years of inserting the prosthesis. Modelling studies have shown that especially in low-level tasks, requiring only a low degree of humeral elevation, impingement can occur. There is therefore a need for a reverse shoulder prosthesis which reduces or eliminates impingement. Such a device may extend the life of the pros thetic device, reduce the risk of potential dislocation and reduce the risk of damage to the Scapula According to a first aspect, the invention provides a Scapula component for a reverse shoulder prosthesis compris ing a part spherical, convex, Surface which is less than a hemisphere and wherein the part spherical Surface does not have a rotational axis of symmetry The part spherical surface may have one or more planes of symmetry. Preferably the part spherical surface only has one plane of symmetry Preferably the part spherical, convex, surface com prises a main circular Surface portion and one or more Sub sidiary Surface portions depending from the edge of the main Surface portion According to a second aspect, the invention pro vides a Scapula component for a reverse shoulder prosthesis comprising apart spherical, convex, Surface which is less than a hemisphere, wherein the part spherical, convex, Surface comprises a main circular surface portion and one or more Subsidiary Surface portions depending from edge of the main Surface portion Preferably the edge of the main circular surface portion is defined by a plane which intersects the part spheri cal Surface Preferably the main circular surface portion is the area bounded or defined by the largest circle that will fit onto the part spherical Surface The one or more subsidiary surface portions may depend from only a part, or from all, of the edge of the main circular Surface portion Preferably the scapula component comprises two Subsidiary Surfaces on opposite sides of the main Surface portion. Preferably the two subsidiary surfaces are crescent shaped Preferably the scapula component comprises a third subsidiary surface which extends from the circular edge at the top of the main Surface portion The main surface portion and the one or more sub sidiary Surfaces together form the part spherical Surface. All the surfaces which form the part spherical surface have the same radius of curvature. The overall shape of the part spheri cal surface is preferably determined by where load forces will be placed on the Surface of the Scapular component when it is in use. An aim is to have a part spherical Surface which includes only the load bearing those surfaces which would be present if the Surface was hemispherical Preferably the transition between the main surface portion and the Subsidiary Surface portions is Smooth, and may form one continuous Surface with a constant radius of Curvature Preferably the part spherical surface does not have a rotational axis of symmetry. The part spherical Surface may have one or more planes of symmetry Preferably the main surface portion of the part spherical Surface has a rotational axis of symmetry Preferably the surface area of the main surface por tion of the part spherical Surface is less than the Surface area of a hemisphere. Preferably the surface area of the part spheri cal Surface is less than the Surface area of a hemisphere Preferably the surface area of the part spherical sur face is less than the surface area of a hemisphere with the same radius of curvature as the part spherical Surface Preferably the two most distant points on the edge of the part spherical Surface are spaced apart by less than two times the radius of curvature of the part spherical surface Preferably the surface area of the part spherical sur face is at least about 5% less than the surface area of a hemisphere which has the same radius of curvature as the part spherical surface. Preferably the surface area of the part spherical surface is between about 5% and about 30% less, more preferably between about 20% and about 30% less, than the surface area of a hemisphere which has the same radius of curvature as the part spherical surface. Preferably the surface area of the part spherical surface is at least about 6, 7, 8, 9, , 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 or 30%, less than the surface area of a hemisphere which has the same radius of curvature as the part spherical Surface Preferably the surface area of the main surface por tion of the part spherical surface is at least about 5% less than the surface area of a hemisphere with the same radius of curvature as the part spherical Surface and the main Surface portion. Preferably the surface area of the main surface por tion is between about 5% and about 35% less, more prefer ably between about 20% and about 35% less, than the surface area of a hemisphere which has the same radius of curvature as the part spherical Surface and the main Surface portion. Preferably the surface area of the main surface portion is at

19 US 2010/O A1 May 20, 2010 least about 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34 or 35%, less than the Surface area of a hemisphere which has the same radius of curvature as the part spherical Surface and the main Surface portion Preferably the volume occupied by the portion of the Scapula component with a part spherical Surface is between about 5% and about 50% less than the Volume that would be occupied by a hemisphere with the same radius of curvature, preferably the volume occupied is between about 10% and about 30% less Preferably the volume occupied by the scapulacom ponent of the invention is less than the Volume a hemisphere comprising the same radius of curvature as the part spherical portion of the Scapula component would occupy Preferably the part spherical surface defines a bear ing Surface which in use contacts the humerus component of a reverse shoulder prosthesis Preferably the part spherical surface forms the front face of the Scapula component The part spherical surface may have a radius of curvature of between about 10 mm and about 30 mm, prefer ably between about 15 mm and about 25 mm, more preferably between about 18 mm and about 22 mm In known reverse shoulder prostheses the scapula component comprises a Substantially hemispherical Surface which forms the bearing surface. The requirement that the component is hemispherical has dictated the size of the Scapula component that can be used in a reverse shoulder prosthesis. Insertion of the Scapula component during shoul der replacement surgery is difficult, and there is little room for the Surgeon to manoeuvre. Surgeons have therefore preferred to use Smaller Scapula components, typically with a hemi spherical bearing surface having a diameter of between 36 and 38 mm (a radius of curvature of 18 or 19 mm). Although components with larger diameters, say 40 or 42 mm (radius of curvature of 20 or 21 mm) are known, the increase in size makes them difficult to position in the scapula and therefore unpopular with Surgeons and much less commonly used However, a scapula component according to the invention in which the part spherical Surface is less than a hemisphere, and is shaped to retain only those surfaces which are needed to take the bearing/forces put on the component in use, takes up less Volume than a hemispherical component with the same radius of curvature. A Scapula component according to the invention with a part spherical Surface which has a radius of curvature of between about 18 and about 22 mm, may take up a Volume which is same, or less than a conventional Substantially hemispherical prostheses with a diameter of 36 or 38 mm (a radius of curvature of 18 or 19 mm). By way of example, a scapula component according to the invention with a radius of curvature of 21 mm may be configured to occupy the same, or less, Volume than a Delta(R) III scapula component from DePuyTM with a diameter of 36 mm (a radius of curvature of 18 mm) The advantage of providing a surface which is part spherical, but less thanahemisphere, is that the advantages of having a surface with a larger radius of curvature can be obtained without having to increase the overall size and/or Volume of the Scapula component. Having a bearing Surface with a larger radius of curvature minimises the risk of impingement of the underlying bone, as the larger radius of the bearing Surface of the Scapula component drives the cup on the humeral component away and therefore reduces the risk of impingement Scapula components according to the invention may therefore be smaller, than known hemispherical components with the same radius of curvature, and may therefore be easier to insert during Surgery Preferably the scapula component comprises a mounting means to mount the Scapula component either directly or indirectly to the scapula The mounting means may be a hole or a screw or any other suitable fixation means which extends from the front of the Scapula component to the back of the Scapula component. Preferably the mounting means has a longitudinal axis Preferably the main surface portion of the part spherical Surface of the Scapula component has a rotational axis of symmetry that is offset at an angle from the longitu dinal axis of the mounting means. Preferably the two axes are offset by an angle of between about 5 degrees and about 45 degrees, preferably the two axes are offset by an angle of between about 10 and about 30 degrees. Preferably the two axes are not laterally displaced The benefit of offsetting the rotational axis of sym metry of the main Surfaceportion of the part spherical Surface, relative to the longitudinal axis of the mounting means, is that it allows the part spherical Surface of the Scapula component to be more easily positioned for contact with a humeral com ponent when in use Preferably the surface area of the part spherical sur face is less than the surface area of a hemisphere with the same radius of curvature due to the removal of material at the base of the hemisphere. Preferably the part of the hemisphere that is missing in the part spherical Surface would not have been load bearing if it had been present in the Scapula com ponent of the invention In addition to the part spherical surface the scapular component may also comprise a part cylindrical Surface. Preferably the part spherical surface and the part cylindrical Surface are on the front of the Scapular component Preferably the part cylindrical surface extends from the back of the part spherical surface. Preferably, the part cylindrical Surface does not form part of the bearing Surface of the Scapula component. The part cylindrical Surface may be included on the Scapula component to assist in fixation of the Scapula component to the Scapula, either directly or indi rectly The scapula component may be attached directly or indirectly to the Scapula. If the component is attached indi rectly a mounting member may be used. The mounting mem ber may attach on one side to the Scapula and on the other side to the Scapula component. Preferably the mounting member has a convex back Surface which, in use, contacts the Scapula According to a further aspect the invention provides a humerus component for a reverse shoulder prosthesis com prising a cup member having a part spherical, concave, bear ing Surface Surrounded by an oval rim Preferably the part spherical bearing surface of the cup member is configured to match, and in use contact, the part spherical bearing Surface of a Scapula component The part spherical surface of the cup member may have a radius of curvature of between about 10 mm and about 30 mm, preferably between about 20 mm and about 25 mm. more preferably between about 18 mm and about 22 mm.

20 US 2010/O A1 May 20, Preferably the rim surrounding the part spherical bearing surface is not of an even width. Preferably the rim includes a wider portion which extends around between about 10% and about 50% of the edge of the part spherical bearing surface. Preferably, in use, the wide rim portion is located inferior to the narrow rim portion. Preferably the transition between the wide rim portion and the narrow rim portion is gradual. In use the wide rim portion is intended to be posi tioned where the cup portion will bear most of the load from the Scapula component. This is typically in an inferior posi tion relative to the narrow rim portion. Preferably the rim is between about 0.2 mm and about 10 mm wide The wide and narrow profile of the rim defines the oval mounting in which the spherical bearing Surface is located Preferably the rim is chamfered. Preferably it is chamfered away from the edge of the part spherical bearing surface. Preferably the rim is chamfered to reduce the risk of impingement of the Scapula by the humerus component, with out compromising joint stability The humerus component may be arranged to be mounted directly to the humerus of a patient, or it may be arranged to be mounted via a cup Support and/or an anatomi cal stem Preferably the humerus component is arranged to be mounted at an angle between about 55 and about 70 degrees, preferably about 60 degrees, relative to the longitudinal axis the mounting stem and/or to the longitudinal axis of the humerus. At an angle of about 60 degrees the risk of impinge ment on the Scapula is reduced According to a further aspect, the present invention provides a reverse shoulder prosthesis comprising a scapula component according to the first or second aspect of the invention and a humerus component according to the third aspect of the invention The part spherical (bearing) surface of a scapula component according to the invention may be made of stain less steel, titanium, cobalt chrome, a combination thereof or any other Suitable material The bearing surface of a humerus component according to the invention may be made of polyethylene, Such as ultra high molecular weight polyethylene which may have been cross-linked, or any other Suitable material Embodiments of the present invention will now be described in more detail, by way of example only, with ref erence to the following figures FIG. 1A shows a schematic perspective view of a reverse shoulder prosthesis according to an embodiment of the invention; 0052 FIG. 1B shows a schematic perspective view of a reverse shoulder prosthesis according to an embodiment of the invention located in a shoulder; 0053 FIG. 2A shows a sketch drawing of a prior art reverse shoulder prosthesis, the arrow indicates where impingement has occurred and the bone can be seen to be notched; 0054 FIG. 2B is a photomicrograph of a section through a shoulder with a reverse prosthesis according to the prior art; 0055 FIG. 2C is a photograph of a shoulder with a reverse prosthesis according to the prior art; 0056 FIGS. 3A to 5 show perspective side and plan views ofa Scapula component according to a first embodiment of the invention; 0057 FIGS. 6A to 8A show perspective side and plan views of a Scapula component according to a second embodi ment of the invention; FIG. 8B shows a perspective side view of a scapula component according to a third embodiment of the invention; 0059 FIGS. 9A to 9Cshow perspective views of a scapula mounting component according to an embodiment of the invention; 0060 FIG. 10 shows a perspective view of a scapula mounting component and a scapular component according to the second embodiment of the invention; and 0061 FIGS. 11A to 11D show perspective views of a humerus component according to an embodiment of the invention Referring to the drawings, FIG. 1A shows a reverse shoulder prosthesis according to the invention comprising a Scapula component 1 and a humerus component 200. The bearing Surface 3 of the Scapula component 1 is shown in contact with the bearing surface (not visible) of the humerus component 200. In use (FIG. 1B), the scapula component 1 is mounted in the glenoid cavity on a patient's Scapula 8 and the humerus component 200 is mounted to the proximal end of the patient's humerus 2. In use, the bearing surface 3 on the Scapula component 1 interacts with the bearing Surface of the humerus component 200 to allow the humerus 2 to move relative to the scapula FIGS. 2A and 2B illustrate a prior art reverse shoul der prosthesis. FIG. 2A schematically illustrates notching (indicated by the arrow) on a shoulder fitted with a reverse shoulder prosthesis. It is believed that this notching may be caused by impingement of the Scapula by the humerus com ponent of the prosthesis. FIG. 2B is a photomicrograph of a section in the frontal plane through the glenoid and the Scapula component of a shoulder prosthesis, illustrating the erosion of the inferior pole of the glenoid, leaving the pros thesis unsupported by bone. FIG. 2C is a photograph showing the erosion around the inferior pole of the glenoid and the scapula neck. The inferior screw and the inferior part of the glenoid base plate (mounting portion) of the Scapular com ponent are denuded of bone. Wear of the polyethylene cup portion of the humerus component is also visible (Nyffeler et al (2004) J Bone Joint Surg Br86-B: ) FIGS. 3A to 5 illustrate, in more detail, a scapula component 1 according to a first embodiment of the inven tion FIGS. 3A to 3D show a scapula component 1 according to the invention with a part spherical, convex, Sur face which is less than a hemisphere. The part spherical, convex, Surface comprises a main Surface portion 3 and three subsidiary surface portions 5, 6, 7 depending from the edge of the main Surface portion 3. These portions are more clearly depicted in FIGS. 4 and 5. In FIG.4, a plan view of the scapula component 1, a circle 4 has been drawn onto the Surface of the part spherical surface 1 to clearly illustrate the main surface portion 3. The circle 4 drawn is the largest circle that can be placed on the part spherical Surface, and defines the main surface portion 3. In FIG. 5, a side elevation of the scapula component 1, plane 8 defines the circular edge of the main surface portion The main surface portion 3 is circular, and the three subsidiary surface portions 5, 6, 7 which depend from the edge of the main Surface portion 3 are crescent shaped. The subsidiary portions 5 and 6 are mirror images of each other and are located on opposite sides of the main Surface portion

21 US 2010/O A1 May 20, The crescents of subsidiary portions 5 and 6 are elongated. The third subsidiary portion 7 is located at the top, superior, edge of the main Surfaceportion3 and is also crescent shaped, but is less elongated than portions 5 and Preferably the subsidiary surface portions have a total surface area which is less than the surface area of the main surface portion. Preferably the total surface area of the subsidiary surfaceportions is less than about 90%, 80%, 70%, 60%, 50%, 40% or 30% of the surface area of the main surface portion. Preferably the width of a subsidiary portion, at its widest part, is less than about 10 mm, more preferably it is less than about 5 mm The main 3 and subsidiary 5, 6, 7 surface portions together form the part spherical Surface of the Scapular com ponent 1. In use this surface forms the bearing Surface that contacts the humerus component of the reverse shoulder pros thesis Modelling studies have shown that the subsidiary surface portions 5, 6, 7 are needed, in addition to the main surface portion 3, in order to bear the load when a reverse shoulder is in use FIGS. 3D and 5 illustrate the difference between the Scapula component 1 of the invention and a hemisphere. It is clear that the Scapula component of the invention is signifi cantly less than a hemisphere. The Scapula component 1 is shown located in a hemisphere defined by lines 11 and 12. The figures illustrate that it is the base of the hemisphere, which would have reached line 12, that has been removed/is missing from the scapula component 1 when compared to a hemisphere The scapula component 1 also has a hole 14though it, which extends from the main surface portion 3 of the part spherical Surface of the Scapular component 1 into a cavity 16 defined by the scapular component 1. The hole 14 defines a longitudinal axis indicated by the dashed line 15 in FIG The main portion 3 of the part spherical surface has a rotational axis of symmetry, illustrated by the dashed line 17 in FIG. 5. The rotational axis of symmetry 17 of the main surface portion 3 of the part spherical surface is offset relative to the longitudinal axis of hole Hole 14 acts as a mounting means and allows a screw, or any other Suitable fixing means to pass through the Scapula component 1 to attach the component directly to the Scapula or to a mounting means, in the embodiment illus trated the Scapula component 1 would usually be attached to a mounting means and then to the Scapula FIG. 6A to FIG. 8A show a second embodiment of the scapular component 100 to that depicted in FIGS. 3A to 5. In this embodiment the Scapular component comprises a part spherical Surface and a part cylindrical Surface The part spherical surface is the same shape and configuration as illustrated in FIGS. 3A to 5 and is indicated by dotted line 119 in FIGS. 7 and 8A More specifically, the scapula component 100 com prises a part spherical, convex, Surface 110 and a part cylin drical surface 120. The part spherical surface 110 is front facing and comprises a main Surface portion 103 and three subsidiary surface portions 105,106, 107 depending from the edge of the main surface portion 103. The circle 104 in FIG. 7 illustrates the boundary of the main surfaceportion 103. The circle 104 is the largest circle that can be placed on the part spherical surface. FIG. 8A shows a side elevation of the scapula component 100, in which plane 108 defines the cir cular edge of the main surface portion As in the first embodiment illustrated in FIGS. 3A to 6, the main surface portion 103 is circular, and the three subsidiary surface portions 105,106, 107 which depend from the edge of the main Surface portion 3 are crescent shaped In use the part spherical surface 110 forms the bear ing Surface that contacts the humerus component of the reverse shoulder prosthesis. (0079. As in FIGS. 3A to 5the scapula component 100 also includes a hole 114, which extends from the main surface portion 103 of the part spherical surface of the scapular com ponent 100 into a cavity 116 defined by the scapular compo nent 100. The hole 114 defines a longitudinal axis which is offset from the rotational axis of symmetry on the main Sur face portion The skilled man will appreciate that the cavity 116 may be of any suitable shape, including domed (as illus trated), cylindrical and cuboid, provided that it can be mounted to a mounting member or directly to a scapula. I0081. In addition to the part spherical surface 110, the Scapula component 100 includes a part cylindrical Surface 120. The part cylindrical surface 120 extends backwards from at least a part of the back edge of the part spherical Surface 110. The depth of the part cylindrical surface 120 varies along its length. The part cylindrical surface 120 extends from most of the back edge of the part spherical surface 110. The part cylindrical surface 120 may extend from between about 50% and about 100% of the back edge of the part spherical surface 110. I0082. The part cylindrical surface 120 has a back edge 127 which is substantially flat. In use, the back edge 127 of the part cylindrical Surface 120 typically contacts the Scapula. I0083. In the embodiment illustrated the back edge 127 of the part cylindrical surface 120 is a few millimetres, about 2 mm, short of reaching the plane where the back Surface of a hemisphere with the same radius of curvature as the part spherical surface 110 would have been. This leaves a lip 113 at the inferior edge of the part spherical surface 110. The skilled man will appreciate that this distance could be greater, or that the back surface 127 could extend to where the back surface of the hemisphere would have been as depicted in FIG. 8B. I0084 FIGS. 9A to 9C depict a mounting member 130 which may be used to mount the scapula component of FIGS. 6A to 8A to a Scapula. The mounting member is arranged to be mounted onto the prepared Surface of a patient's Scapula (not shown) and then to engage with the cavity 116 in the scapula component 100. I0085 Mounting member 130 is essentially domed shape. The top of the dome has been removed to leave a concave top surface 128. Sidewalls 121 slope from the top 128 to meet a base 123. The base 123 of the mounting member 130 has a convex surface 127. Preferably the convex surface 127 allows the base 123 to fit to the contours of the scapula, providing improved contact and reducing stresses. A mounting projec tion 129 extends from the base 23. The mounting projection 129 has a longitudinal axis 122 as shown in FIGS. 9A and 9C. Preferably the longitudinal axis 122 of the mounting projec tion 129 is on the same axis as the longitudinal axis 115 of the scapular component 100 when the two components are fixed together (FIG. 10C). The mounting projection 129 is tubular, and the free end 131 has a chamfered edge 133. Four support ing struts 135 are equally spaced around the mounting pro jection 129. The mounting projection 129 may define a hole which is used to screw the mounting member 130 to a scapula.

22 US 2010/O A1 May 20, 2010 Preferably a corresponding hole is made in the patient's Scapula to accommodate the mounting projection 129. I0086 Four screw recesses 137 are equally spaced around the circumference of the mounting member 130 in the side walls 121 of the mounting member 130. A screw hole 139 extends from each of the screw recesses 137 through to the base 123. Each screw recess 137 is large enough to accom modate ahead of a screw 141. FIG.9C shows a screw 141, as it would be positioned in a screw recess 137 and screw hole 139 when the mounting member is attached to the scapula (not shown) A screw hole 143 is located in the centre of the flattened top 128 of the mounting member 130. The screw hole 143 has alongitudinal axis 122 in FIGS.9B and 9C. This screw hole 143 extends through the centre of the mounting member 130 and through the tubular mounting projection 129. The screw hole 143 is capable of accommodating a central screw (not shown) which can secure the mounting member 130 to a patient's scapula (not shown) The mounting member 143 may be attached to the Scapula using four circumferential Screws, or by using a cen tral screw located in hole 143, or by using both means As an alternative to locating a screw in the central screw hole 143, the outer surface of the mounting projection 129 may be threaded and may screw directly into the scapula The fixing means discussed in the specific example are just one example of how the Scapular component may be mounted, and the skilled man will appreciate that the device may be mounted in any suitable way. For example more or less fixing means than illustrated may be used. The fixing means may include screws, pins, nail, staples and any other Suitable means Referring to FIG. 10, screw hole 143 in the mount ing member 130 is arranged to align with hole 114 in the Scapula component 100, and a central Screw (not shown) can be used to secure the Scapula component 100 to the mounting member FIGS. 11A to 11D show a humerus component 200 according to the invention. The humerus component 200 comprises an upper cup portion 202 (FIG. 11D) and a lower mounting portion 204 (FIG. 11C) The cup portion202 comprises a front facing convex part spherical surface 206 surrounded by an oval shaped rim 208 with a chamfered surface. The side of the cup portion forms a cylindrical surface 209. In use, the convex surface 206 forms a bearing Surface which contacts the Scapula compo nent. The underside (not shown) of the cup portion 202 is substantially flat The width of the rim 208 varies around the part spherical surface 206. At the lower/inferior end of the part spherical surface 206, the rim 211 is wider than at the upper/ superior end of the part spherical surface 206, where the rim 212 is narrower. This difference in width of the rim is deter mined by how much load a particular part of the humerus component 200 will take when in use. For example, in use a lot of the load forces will be concentrated at the lower inferior end of the part spherical surface 206, where the rim 212 is wider. The wider rim 212 allows these forces to be absorbed and reduces the risk of damage to the prosthesis. Where the rim is narrower, for example at the upper end of the part spherical Surface 206, the forces on the corresponding part spherical surface 206 are less and thus a narrower rim 212 can be used The chamfering on the rim 208 is designed to mini mise impingement on the Scapula which may becaused by the humerus component. As the bearing/load forces do not act directly on the surface of the rim 208, the rim can be cham fered without affecting performance of the prosthesis. (0096 Preferably the top surface on the cup portion 202 does not all lie in the same plane. As depicted in FIG.11B, the lower half of the top surface of the cup portion 202 is about 2 degrees (illustrated as angley) from the plane 240 define by the central part of the top surface of the cup portion 202, and the upper half of the top surface of the cup portion 202 is 5 degrees (illustrated as angle x) from plane 240. The skilled man will appreciate that this is merely an example and that these angles can be varied somewhat and that the top Surface may all lie in the same planar. The angling of the upper surface is intended to further minimise the risk of the humerus component impinging on the Scapula The cup portion 202 also comprises a stem 215 which projects from the lower surface of the cup portion 202. The stem 215 is tubular and is arranged to mount the cup portion on the lower mounting portion 204. (0098. The side 209 and the underside (not shown) of the cup portion 202 has a notch 218 at the lower most edge. This notch 218 engages with a corresponding raised portion 227 on the mounting portion 204. The notch 218 and raised por tion 227 are designed to impart more strength to the lower end of the humerus component 200 where most of the load is concentrated when the component 200 is in use. The reason for this arrangement is that the lower mounting portion 204 is made of a stronger material, typically metal, which will pro vide the strength needed to support the load and reduce the risk of damage to the prosthesis The lower mounting portion 204 comprises a Sup port portion 221, configured as a disc, with an upper Surface 223 having a small spherical curvature and a lower flat surface (not shown). The Small spherical curvature on the upper Sur face 223 reduces torsional stresses on the portion. The upper surface 223 carries a raised portion 227 which corresponds to the notch 218 on the underside of the cup portion The upper surface 223 of the humerus mounting portion 204 has a cup-portion mounting hole 229 which extends through the humerus mounting member 204 and partially into a stem 224 projecting from the underside of the support portion 221. The cup-portion mounting hole 229 engages with the cup mounting projection 215 on the cup portion 202. The hole 229 and the projection 215 can be any Suitable complementary shape. They may be oval to prevent rotation The stem 224 projectsatanangle of 60 degrees from a plane defined by the lower Surface of the mounting portion 204. This angle may be varied, however the intention is that the part spherical cup of the cup portion is presented to the Scapula component at an angle of about 60 degrees to the longitudinal axis of the humerus The stem 224 is tubular and is capable of fitting into a standard or custom anatomical stem (not shown). The stem may have any Suitable cross sectional shape. The stem may be oval to prevent any rotation when in use. (0103. The transition between the stem 224 and the lower Surface of the mounting portion 204 is a Smooth gradual slope. A strut 233 extends from the lower surface of the mounting portion 204 to half way along the stem 224 and serves to prevent rotation of the stem once in situ in a standard or custom anatomical stem.

23 US 2010/O A1 May 20, A Scapula component for a reverse shoulder prosthesis comprising a part spherical, convex, Surface having an area which is less than that of a hemisphere of the same radius of curvature and wherein the part spherical Surface does not have a rotational axis of symmetry. 2. A Scapula component according to claim 1, wherein the part spherical, convex, Surface comprises a main circular Surface portion and one or more Subsidiary Surface portions extending from the main circular Surface portion. 3. A Scapula component for a reverse shoulder prosthesis comprising a part spherical, convex, Surface having an area which is less than that of a hemisphere of the same radius of curvature, wherein the part spherical, convex, Surface com prises a main circular Surface portion and one or more Sub sidiary Surface portions extending from the main circular Surface portion. 4. (canceled) 5. A Scapula component according to claim 2, wherein the main circular Surface portion is an area defined by the largest circle that will fit onto the part spherical surface. 6. (canceled) 7. A Scapula component according to claim 2, wherein the Scapula component comprises two Subsidiary Surfaces on opposite sides of the main circular Surface portion. 8. A Scapula component according to claim 7, wherein the main circular Surface portion has a Superior edge and the Scapula component comprises a third Subsidiary Surface which extends from the Superior edge. 9. (canceled) 10. A Scapula component according to claim 2, wherein the main circular Surface portion of the part spherical Surface has a rotational axis of symmetry. 11. A Scapula component according to claim 2, wherein the area of the main circular Surface portion of the part spherical surface is between about 5% and about 35% less than the Surface area of a hemisphere with the same radius of curva ture as the part spherical Surface. 12. A Scapula component according to claim 2, wherein the area of the part spherical surface is between about 5% and about 35% less than the surface area of a hemisphere with the same radius of curvature as the part spherical Surface. 13. (canceled) 14. A Scapula component according to claim 2, wherein the area of the part spherical surface is at least about 5% less than the surface area of a hemisphere which has the same radius of curvature as the part spherical Surface. 15. A Scapula component according to claim 2, wherein the Volume occupied by the portion of the Scapula component with a part spherical surface is between about 5% and about 50% less than the volume that would be occupied by a hemi sphere with the same radius of curvature. 16. A Scapula component according to claim 2, wherein the part spherical Surface defines a bearing Surface which in use contacts a humerus component of a reverse shoulder prosthe S1S. 17. A Scapula component according to claim 2, wherein the part spherical surface has a radius of curvature of between about 18 mm and about 22 mm. 18. A Scapula component according to claim 2, wherein the Scapula component comprises a mounting means to mount the Scapula component either directly or indirectly to a Scapula. 19. A Scapula component according to claim 18, wherein the main circular Surface portion of the part spherical Surface of the Scapula component has a rotational axis of symmetry, the mounting means has a longitudinal axis, and the rotational axis is offset at an angle from the longitudinal axis. 20. A Scapula component according to claim 2, further comprising a part cylindrical Surface, wherein the part spheri cal Surface has a back portion and the part cylindrical Surface extends from the back portion of the part spherical surface. 21. (canceled) 22. (canceled) 23. (canceled) 24. A humerus component for a reverse shoulder prosthesis comprising a cup member having a part spherical, concave, bearing Surface Surrounded by an oval rim. 25. A humerus component according to claim 24, wherein the part spherical bearing Surface of the cup member is con figured to match, and in use contact, a part spherical bearing surface of a scapula component. 26. A humerus component according to claim 24, wherein the rim Surrounding the part spherical bearing Surface is not of an even width. 27. A humerus component according to claim 26, wherein the rim comprises a wide portion and a narrow portion and, in use, the wide portion is located inferior to the narrow portion. 28. A humerus component according to claim 24, wherein the humerus component has a longitudinal axis and is arranged to be mounted at an angle between about 55 and about 70 degrees, relative to the longitudinal axis. 29. A reverse shoulder prosthesis comprising; a Scapula component having a part spherical, convex, Surface having a surface area which is less than that of a hemisphere of the same radius of curvature and wherein the part spherical Sur face does not have a rotational axis of symmetry; and a humerus component comprising a cup member having a part spherical, concave, bearing Surface Surrounded by an oval rim. 30. (canceled) 31. (canceled) 32. (canceled)